Flashcards in Lecture 10 Deck (13):
what are the indications (uses) of irreversible occlusal therapy?
1. treatment of TMDs
2. treatment of other dental condx --> decay teeth, missing, broken (anything that irreversibly alters occ)
how do we know when to use irreversible OT for TMD? --when we are sure occlusion is a cause of TMD and the reason why reversible (OA) therapy was a success;
OCCLUSION IS AN ETIOLOGIC FACTOR IN THAT IT A) CHANGES ACUTE OCC. = ALTERED SENSORY INPUT (PROTECTIVE CO CONTRACTION) AND B) ORTHO. INSTABILITY (with sufficient loading)
malocclusion = maybe missing a tooth? overbite? but still no issues-->don't have to treat
if TMD is diagnosed, OTHER TREATMENT SHOULD NOT BEGIN UNTIL IT HAS BEEN RESOLVED (unless emergency)--e.g. bruxism = fix before you put in a new bridge
what are the tx goals for occlusal therapy?
1. condyle in CR (superoanterior) --> MSS
2.AD properly interposed
3. post teeth contact evenly and simultaneously; cusp tips on flat surface, axial loading
4. ant teeth disclude post teeth in eccentric mvments
5. in alert feeding position, post ttooth contacts are heavier than ant
basically provide orthopedic stability (MSS in harmony with stable occlusion)
what is the least to most invasive tx for occlusal therapy?
selective grinding --> fixed/removable prostho-->orthodontics-->orthognathic surgery
what factors influence tx decisions?
1. symptoms -- minor symptoms = NOT major tx
2. condition of dentition = minimize removal of sound tooth structure
3. systemic health = general health can affect prognosis
4. esthetics = important
why is an articulator useful?
1. aids in diagnosis--see static tooth-tooth in CR (trying to set them to CR as it is MSS) contact without intfx of soft tissue, from new angles, don't need px to be there; can also see dynamic to functional contact and may be able to dx some new intfx
2. aids in tx planning--can see if selective grinding will work; can see how diagnostic waxups function/look esthetically; px education so they understand and can have a say
3. aids in the provision of tx--needed to make fixed and removeable prostho
what are the types of articulators?
when to use nonadjustable articx?
-in pts with good occ already (must hand articulate)
-in pts requiring single simple restos with excellent ant. guidance in early excursive mvmnts
advx of semi adjustable articx?
-can duplicate condylar mvmnt
-allows eccentric mvmnt
-can duplicate 3 PCFs:
1/ condylar inclination --> can play fossa depth ad height
2. bennett angle/lateral trans movement (can widen or narrow the angle bw medio and laterotrusive pathways on occx surface)
3. intercond. distance --> helps plan mediotrusive and laterotrusive pathways of post supporting cusps
-requires less chairside alterations